口服维生素D3对维生素D不足绝经后妇女血清25－羟维生素D、骨密度和下肢肌力的影响

摘要

目的：给予不同年龄、维生素D不足的绝经后妇女口服1325 U维生素D3，观察其对血清总25－羟维生素D （25OHD）水平、骨密度（ BMD）和下肢肌力（行走八步计时）的影响。方法上海市某社区67名绝经后妇女纳入本研究，按年龄将受试者分成2组：＜70岁组[ n＝35，（63．6±5．1）岁]，≥70岁组[ n＝32，（75．2±3．4）岁]。受试者口服1200 U／d维生素D3制剂加1片钙尔奇D （每片含维生素D3125 U和钙600 mg），为期1年。在0、3、6、9和12个月检测血清25OHD，干预前和研究结束时测定BMD及下肢肌力。结果干预1年后，2组平均血清25OHD水平均较基线值显著升高：＜70岁组从（17．8±6．7） ng／mL升至（33．8±5．8） ng／mL （P＜0．001）；≥70岁组从（18．3±6．7） ng／mL升至（34．1±5．7） ng／mL （P＜0．001），但2组间增幅差异无统计学意义。有25％受试者（＜70岁组9名，≥70岁组6名）平均血清25OHD仍低于30 ng／mL。＜70岁组血清甲状旁腺素（PTH）明显降低，从（46．0±14．7） pg／mL降至（37．9±10．0） pg／mL （ P＜0．01），各部位BMD较基线值无统计学差异。≥70岁组腰椎BMD提高1．37％（P＝0．005），全髋部位BMD提高1．28％（ P＝0．028）。2组干预后下肢肌力均较干预前改善（ P＜0．05）。2组均未出现高钙血症及过高的血清25OHD浓度。结论2组维生素D不足的绝经后妇女每日口服1325U维生素D3可将血清25OHD升至理想水平，可改善下肢肌力，≥70岁组腰椎及全髋部BMD均有上升。%Objective To evaluate the effects of daily supplement of 1 325 U cholecalciferol for one year on cir-culation serum 25-hydroxyvitamin D [25OHD] level, bone mineral density ( BMD) and lower extremity function in post-menopausal women with vitamin D insufficiency.Methods Sixty-seven postmenopausal women were recruited from urban area of Shanghai.The subjects were divided into two groups based on age: <70 years group (n=35, 63.6 ±5.1 years) and≥70 years group (n=32, 75.2 ±3.4 years).All subjects received a daily supplement of 1 200 U cholecalciferol and a tablet of Caltrate D ( calcium 600 mg plus 125 U cholecalciferol) for one year.All subjects were followed up on month 0, 3, 6, 9, and 12 after the intervention.Serum 25OHD was evaluated by liquid chromatography-tandem mass spectrometry method.BMD was determined by Dual energy X-ray absorptiometry and lower extremity function was esti-mated by time for the 8-step walk on month 0 and month 12.Results After one-year intervention, the serum 25OHD concentration in both the <70 years group and≥70 years group were significantly increased (P<0.01);the level of <70 years group changed from 17.8 ±6.7 ng/mL to 33.8 ±5.8 ng/mL, and≥70 years group from 18.3 ±6.7 ng/mL to 34.1 ±5.7 ng/mL.But no difference was observed between the two groups.25% of subjects ( 9 cases in <70 years group and 6 cases in≥70 years group) had serum 25OHD lower than 30 ng/mL.The level of serum PTH in <70 years group was significantly decreased from 46.0 ±14.7 pg/mL to 37.9 ±10.0 pg/mL (P<0.01).No individual developed hypercalcemia in this study.At the end of study, lumbar spine BMD increased by 1.37% ( P=0.005 ) , and total hip BMD increased by 1.28%(P=0.028) in ≥70 years group.The time for the 8-step walk at month 12 was shorten in both groups compared to base line.Conclusion A daily supplement of 1325 U cholecalciferol for one year increased serum 25OHD to a level higher than 30 ng/ml in postmenopausal women with vitamin D insufficiency.The BMD at lumbar spine and total hip increased in≥70 years group (P<0.05).The lower extremity function was improved in both groups.